1/7. An opportunity for office-based research.Robert, a nearly 12-year-old boy, traveled an hour to see a new pediatrician. Robert's mom told the pediatrician that Robert had not been seen by a doctor for several years because "no one seems to be able to help him with his problem." Robert had been wetting the bed "ever since he was toilet-trained" at age 2 years. Robert wets the bed about 5 out of 7 nights. He never has daytime accidents. He did not have a history of urinary tract infection, dysuria, urgency, or increased frequency of urination. He has daily bowel movements and denied soiling or accidents. Robert's mom said he had "toilet-trained himself" at age 2 years. Both Robert's mom and maternal grandfather had nocturnal enuresis "into their teenage years." The pediatrician was surprised to learn that another physician had treated Robert with imipramine at age 5 years. The medication worked intermittently and Robert continued to take it for about a year. At age 6 years, Robert's parents saw an advertisement for a bed-wetting alarm. They purchased the alarm but found that Robert never woke up when the alarm sounded. At age 7 years, Robert saw a urologist who told him he would "outgrow the problem." A year later, the urologist prescribed desmopressin acetate (DDAVP) nasal spray, which Robert took on occasion during the next 2 years. Every time he stopped the DDAVP, he resumed wetting the bed. His parents never punished him for his accidents, but they did try restricting fluids after dinner and also woke Robert in the middle of the night and encouraged him to go to the bathroom. Neither of these strategies was successful. Robert said he was "frustrated" and wondered if "I would still be wetting the bed as a grown-up." The pediatrician explained the nature of enuresis to Robert and his mom, provided them with instructions and an order form for a bed-wetting alarm, and arranged a follow-up visit. The next day, during nursery rounds, he asked several of his colleagues about their approaches to the treatment of enuresis. A few used DDAVP, one found imipramine beneficial, and one preferred behavioral treatment with a bed-wetting alarm. The pediatrician became concerned that he had misread the literature on enuresis. He brought the question up at the next pediatric staff meeting at the local hospital. A lively discussion ensued as the physicians realized that they employed a variety of treatments for enuresis. Robert's pediatrician wondered why his colleagues were not using the alarm because the literature seemed to indicate it to be the preferred treatment for enuresis. He asked the group if they would be interested in talking about the issue further and perhaps trying to understand the reasons for their varied approaches to this problem.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
2/7. Secondary diurnal enuresis: evaluation of cueing and reinforcement interventions with a sensory-impaired youth.Secondary enuresis consists of sporadic urinary accidents in persons who, otherwise, possess toileting skills. The present study evaluated the behavioural treatment of secondary enuresis displayed by a 19-year-old, developmentally disabled female with multiple sensory impairments. Treatment consisted of external and self-cueing procedures combined with reinforcement for on-toilet urination. As evaluated in a multiple baseline design, intervention resulted in a decrease in wetting incidents and an increase in self-initiated toileting. Treatment effects were maintained through a 7-month follow-up assessment.- - - - - - - - - - ranking = 224569.2324674keywords = diurnal (Clic here for more details about this article) |
3/7. Bedwetting: a new approach to treatment in a mentally handicapped boy.Lifelong nocturnal enuresis in a 9-year-old boy with Down's syndrome was tackled using progressive lifting, in which he was lifted and potted at a time in the early evening when he was found to be reliably dry. The programme was designed for the boy to be lifted progressively later in the evening until all-night dryness was achieved. However, all-night dryness began to occur 4 months after the start of the programme and lifting was at only half an hour beyond the original time when it was discontinued. Four months after this the boy was completely dry. Possible reasons are discussed.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
4/7. diagnosis of phaeochromocytoma after ingestion of imipramine.An 11-year-old twin girl was admitted to hospital with a 24-hour history of profuse sweating, tachycardia, and hypertension after a single dose of imipramine. She was subsequently found to have a right adrenal phaeochromocytoma. To our knowledge, this is the first reported case of tumour provocation by imipramine.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
5/7. Successful use of the nocturnal urine alarm for diurnal enuresis.We report the effects of using a urine alarm, typically employed for nocturnal enuresis, to treat chronic diurnal enuresis in a 15-year-old female resident at Boys' Town. The results of an ABAB reversal design indicate that the alarm eliminated wetting in both treatment phases and that continence was maintained at 3- and 6-month follow-up.- - - - - - - - - - ranking = 280711.54058424keywords = diurnal (Clic here for more details about this article) |
6/7. Intranasal desmopressin-induced hyponatremia.Desmopressin is a commonly used, well-tolerated agent for the treatment of primary nocturnal enuresis and central diabetes insipidus. Intranasal desmopressin provides symptomatic relief with few serious complications. A 29-year-old woman with a long history of primary nocturnal enuresis began treatment with intranasal desmopressin. Although the enuresis ceased, she developed throbbing headaches, nausea, vomiting, paresthesia, lethargy, fatigue, and altered mental status over the next 7 days. When she came to the emergency room her sodium concentration was 127 mmol/L. The history of desmopressin use was not obtained at that time. She was treated with intravenous fluids and discharged. The symptoms returned and worsened over the next 4 days, and she returned to the emergency room stuporous. A repeat sodium was 124 mmol/L, and she was admitted. The history of desmopressin use was still not available. Medical evaluations included computerized tomography, lumbar puncture, complete blood counts, serum chemistries, and serologies. The next morning the woman was improved and informed clinicians of her desmopressin use. Without other causes for the hyponatremia, she was diagnosed with the syndrome of inappropriate antidiuretic hormone, presumably caused by desmopressin. Within 24 hours of fluid restriction and cessation of desmopressin, her symptoms and hyponatremia resolved. A review of the literature found 11 children and 2 adults in whom intranasal desmopressin was associated with hyponatremia, all of whom experienced seizures or altered mental status. Our patient illustrates the importance of early recognition and treatment of hyponatremia before the onset of seizures. When vague symptoms develop during desmopressin therapy, hyponatremia must be considered as part of the differential diagnosis. It may also be prudent to screen for electrolyte abnormalities in patients taking this agent to prevent serious iatrogenic complications.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |
7/7. central nervous system ischemia after varicella infection and desmopressin therapy for enuresis.A 7-year-old boy had a left-sided cerebrovascular accident 48 hours after beginning intranasal desmopressin acetate (DDAVP) therapy for persistent secondary nocturnal enuresis and approximately 2 weeks after varicella infection. A possible connection between desmopressin therapy or varicella infection (or both) and the patients neurologic symptoms is discussed, as is the relationship of desmopressin with hypercoagulability, Suggestions for patient/parent education, medical history taking, and patient surveillance are offered to prescribing physicians.- - - - - - - - - - ranking = 1keywords = hour (Clic here for more details about this article) |